BCEHS Infectious Disease Care Team
Activation Threshold Guidance
Purpose
The BCEHS Infectious Disease Care Team (IDCT) provides specialized support for the assessment, management and transport of patients with suspected High Threat Pathogens (HTPs).
The IDCT has enhanced HTP PPE training and specialized equipment but requires time to deploy, which includes both ground and air capabilities. This guideline assists Paramedic Specialists and EPOS physicians in determining the most appropriate transport strategy for patients with suspected Ebola Virus Disease (EVD).
Current Ebola outbreaks in DRC, South Sudan and Uganda require heightened awareness when patients present with compatible travel history, exposure risk and symptoms.
Key Facts
Specialized Training
Only IDCT paramedics are trained to manage patients requiring enhanced HTP PPE (i.e., double gloving). This includes patients with active hemorrhage, respiratory secretions, or significant fluid loss in the setting of a known exposure and later-stage EVD symptoms.
PPE
Double gloving is not required for low-risk suspected EVD patients who are not actively hemorrhaging, producing respiratory secretions, or losing fluids.
Transmission
Patients do not transmit Ebola while asymptomatic.
Clinical Decision
Every suspected case should be evaluated individually with the Paramedic Specialist, EPOS and MHO.
Conveyance
Consider self-conveyance whenever clinically appropriate for suspected EVD patients.
Risk: Identified During 9-1-1
Activation Threshold Guidance
Risk Identified
- Patient with Ebola risk factors identified at time of call
- Patient/caller self declares quarantine orders or recent travel
Notification Required
EMCT notifies the PS/Charge Dispatcher
PS/CEMD
- Ensure the call is a WAIT
- Add supporting notes to Supp Info
PS Tasks
- Complete callback to scene to assess risk, questions below
- Notify EPOS and share findings
- Discuss most appropriate risk category with EPOS, categories below
- Conference MHO into call for discussion regarding IDCT activation
- Consider engaging IDCT team for additional support with decision making
Decision Point
Shared decision from EPOS / MHO / PS
⬇️
Choose ONE option
Activate IDCT
- Notify DR3 for activation
- Consider notifying POM for operational awareness
Standard Response
- Dispatch a regular crew with appropriate PPE
- Consider self-conveyance when safe and appropriate
Risk: Discovered by Crew
Activation Threshold Guidance
Risk Identified
Risk factors discovered by crews on scene at time of PCRA
Notification Required
Crew calls CliniCall and shares assessment and concerns
PS/CEMD
- Ensure the call is a WAIT
- Add supporting notes to Supp Info
PS Tasks
-
Complete risk assessment based on information obtained from crew on scene. Consider callback to patient/caller as necessary, questions below
-
Based on suspected risk, PS may request crew withdraw from scene to ensure their safety and allow time for further risk assessment to be completed
-
Decision to withdraw from scene if risks are identified to be made regardless of patient condition
-
-
Notify EPOS and share findings
- Discuss most appropriate risk category with EPOS, categories below
- Conference MHO into call for discussion regarding IDCT activation
- Consider engaging IDCT team for additional support with decision making
Decision Point
Shared decision from EPOS / MHO / PS
⬇️
Choose ONE option
Activate IDCT
- Notify DR3 for activation
- Consider notifying POM for operational awareness
Standard Response
- Dispatch a regular crew with appropriate PPE
- Consider self-conveyance when safe and appropriate
Discriminator Questions
Assess the following
-
Has the patient travelled to DRC, South Sudan, or Uganda within the last 21 days?
-
Has the patient been ordered to quarantine by PHAC?
-
Is there any probable exposure to Ebola?
- In an outbreak area or around anyone who is ill?
- Healthcare worker who worked in a healthcare facility?
- Did the healthcare worker have access to and use appropriate PPE?
- Contact with people in affected provinces?
-
What symptoms are described?
Notes
Consider CareConnect for additional details if the patient has recently been assessed by a physician.
Ebola Symptoms
Symptoms typically begin 2–21 days after exposure.
Initial Symptoms
- Fever / chills
- Headache
- Sore throat
- Weakness
- Fatigue
- Malaise
- Muscle & joint pain
Progressive Symptoms
- Nausea, vomiting, diarrhea
- Rash or red eyes
- Jaundice
- Chest or abdominal pain
- Delirium
- Bruising or bleeding
- Anorexia
- Severe weight loss
⚠ Higher Transmission Risk
- Vomiting
- Diarrhea
- Bleeding / hemorrhage
Risk Categories
Category 1 – No probable exposure to Ebola/Bundibugyo Virus Disease (EVD/BVD)
Definition
- Travellers are placed in this category if they have no known, likely or possible exposure to the Bundibugyo virus (BVD) during the preceding 21 days.
- This applies if the traveller has been in the Democratic Republic of Congo, Uganda or South Sudan during the preceding 21 days but is assessed to have had none of the Category 2 exposures.
Requirements
- Includes the civic address of the place where the person plans to quarantine during the mandatory 21-day quarantine period beginning on the day they enter Canada.
- Includes the person's contact information for the 21-day quarantine period.
- Avoid all physical contact with other people in the household and refrain from sharing objects such as cutlery (if the person is a minor they may have contact with caregivers).
- Avoid all contact with people outside the household unless seeking medical care.
- Have access to necessities of life, including water, food, medication and appropriate environmental temperature control without leaving quarantine.
- Confirm there will be no visitors at the place of quarantine.
- Have access to health services and be able to contact Public Health.
- Follow any additional measures directed by the quarantine officer following the mandatory health assessment.
Guidance
- Asymptomatic Category 1
- Regular crew with POC Risk Assessment
- Symptomatic Category 1
- Regular crew with POC Risk Assessment OR IDCT Activation, depending on the clinical assessment.
Category 2 – Known, or possible exposure to Ebola/Bundibugyo Virus Disease (EVD/BVD)
Definition
Travellers are placed in this category if there IS known, likely or possible exposure1 to Bundibugyo virus in the preceding 21 days. This applies if the traveller has had:
- Percutaneous (i.e., piercing the skin), mucous membrane (e.g., eye, nose or mouth), sexual or skin contact with blood or other body fluids (e.g. semen2, breastmilk) from a person with confirmed Bundibugyo virus disease (BVD) or who is considered likely to have BVD, including through objects contaminated by that person
- Close contact with a person who has confirmed BVD or who is considered likely to have BVD (with or without personal protective equipment)
- Cared for a person with confirmed BVD or who is considered likely to have BVD (with or without personal protective equipment)
- Physical contact with any human remains of a person who has confirmed BVD or who was considered likely to have had BVD (with or without personal protective equipment)
- Lived in the same household as a person with confirmed BVD or who is considered likely to have BVD
- Laboratory or other worker who handled Bundibugyo virus or processed body fluids and/or tissues from a person with BVD or who is considered likely to have BVD (with or without personal protective equipment)
- Healthcare and humanitarian workers who have been in the Democratic Republic of Congo
Requirements
All requirements from Category 1. Additionally, - The place of quarantine must be accessible by ground transportation within 250 km or 3 hours of a “hold and test” facility. - The traveller must have access to a separate bedroom; and - The traveller must have access to a separate bathroom, unless directed otherwise at the discretion of the quarantine officer. - Will receive daily monitoring by public health.
3For healthcare and humanitarian workers without known breaches in personal protective equipment (2B): Allowed to travel to their place of quarantine using commercial transportation as long as they are asymptomatic and can arrive within 24 hours
For any other person in Category 2 (2A): Cannot involve onward travel on commercial transport (e.g., commercial flight, taxi, ride-sharing) so traveller must be able to arrange private transport to their quarantine location
Guidance
- Asymptomatic Category 2
- Regular crew with POC Risk Assessment OR IDCT Activation, depending on the clinical assessment
- Symptomatic Category 2
- IDCT activation
Footnotes
- Exposure to a person with confirmed BVD or who is likely to have BVD refers to exposure that occurred while the person is infectious (i.e., from the onset of symptoms until no longer deemed infectious by their clinical care team).
- For sexual contact, semen from people who have recovered from Ebola disease can remain infectious for months.
- 2A & 2B refers to how survey data is differentiated. When the provinces and territories receive data from PHAC, they will see “Category 2A” and “Category 2B”. 2B refers to humanitarian and healthcare workers
Clinical Note
Risk categories reflect the current guidance based on expert consensus and best practice.
Recommendations may change as PHAC updates its guidance. This page will be reviewed and updated as changes occur.
References
Ebola Virus Disease Infographic
Ebola Preparedness and Paramedic Safety
Review Schedule
| Adopted | Next Review Scheduled | Owner | Reviewer |
|---|---|---|---|
| JUL 2026 | JUL 2027 | Clinical Hub Manager | BCEHS OHS Team |